What's a woman to do if it's all in the womb?

A new book examines how the nine months before birth shape the rest of our lives, writes ANNA MURPHY

ANY WOMAN who has experienced a 21st-century pregnancy will understand what drove Annie Murphy Paul to spend her own pregnancy surrounded by stacks of scientific journals.

Trying to produce a healthy child can be more like a crash-course in biology, dietetics and toxicology than a natural and normal process, so Paul decided to research and document the litany of advice pregnant women receive.

The result was Origins, a book exploring whether a few blasts of hairspray, a soggy tuna sandwich or a threadbare toothbrush can really make a difference to your unborn child.

Answering that question, it turns out, is more mind-bending than the miracle of birth, so much so that it merits its very own branch of medical science: foetal origins.

“Foetal origins research suggests that the lifestyle that influences the development of disease is often not only the one we follow as adults, but the one our mothers practised when they were pregnant with us as well,” writes Paul.

“You can find references to the foetal origins of cancer, cardiovascular disease, allergies, asthma, hypertension, diabetes, obesity, mental illness . . . also our intelligence, temperament, even our sanity.”

Foetal origins proposes that it’s not just the roll of the gene dice that influences your future health – whether your mother was eating a burger and downing a gin while she rolled them counts too. It’s a relatively new and ever-expanding branch of science, some parts of which are pretty conclusive and widely accepted.

There’s little doubt that maternal smoking, excessive drinking, malnourishment and uncontrolled diabetes lead to an increased likelihood of negative outcomes for the child later in life. But beyond these clear-cut cases, much foetal origins research is ambiguous at best and infuriating at worst.

Research into the foetal origins of obesity and mental illness are a case in point. A series of studies at Harvard found that the greater a woman’s weight gain during pregnancy, the higher the risk that her child would be overweight. In relation to obesity, the children of obese mothers who later lost weight showed different outcomes dependent on whether they were born before or after the weight loss.

Yet despite all this, there’s still ambiguity. “It may be that the food choices women make during pregnancy influence the later preferences of their offspring,” says Paul, “or children could well share eating habits, or a genetic predisposition to obesity.”

Whether a mother’s level of stress during pregnancy is related to her baby’s subsequent mental health is hotly disputed. One doctor argues that even ordinary stress can cause early labour or low birth weight, another argues that the umbilical cord breaks down the maternal stress hormone, so it doesn’t reach the baby. And yet another concludes that babies of mothers with some levels of stress fare better than those with none, that “women who experience periods of stress in their daily lives . . . may effectively be giving their foetuses’ nervous systems a beneficial workout”.

Flick to another report and it seems that overly stressed mothers, assuming they don’t have a weight problem, should turn to comfort-eating. One study found that mothers who ate chocolate every day had infants who “showed less fear and laughed more often at six months of age”.

Foetal origins it seems is a very mixed and rather mixed-up bag. You have to wonder how meaningful or accurate correlations like this can be especially when the research, and the pregnancy recommendations that tag along behind it, is constantly evolving.

Even government-endorsed guidelines recommending total abstinence from alcohol during pregnancy were called into question by research from University College London this month. It found that light drinkers were 30 per cent less likely to have children with social or emotional difficulties than those who did not drink in pregnancy.

On the surface it seemed that light drinking was beneficial, but the authors were keen to stress that this correlation was weakened when social factors like the mother’s education level, family income and parental discipline were taken into account. As Paul points out, “Such nuance is seldom found in the public discussion”.

Not only are the actual findings of foetal origins contentious, so too are its implications. Academics in parenting culture studies warn that this intense interest in what happens in the womb is over-medicalising the natural process of pregnancy and infantilising women along the way.

Some doctors have warned that an overemphasis on foetal origins leads adults to a fatalistic approach to their own health: there’s little impetus to change your lifestyle if you believe your future was authored by your genes and written in the womb.

And there’s a fine line between promoting good ante-natal care and laying the health of the population at the feet of the mother-to-be. As Paul ponders when considering the impending obesity crisis, “Helping women maintain a healthy weight before and during pregnancy may be the best hope for stopping obesity before it starts”.

Seeing the full gamut of pregnancy advice writ large in Origins makes you wonder how any woman can navigate pregnancy without becoming mired in guilt and fear. While having all the scientific information to hand can be empowering, instilling a sense that you have “done your best”, for women who don’t have the time, means or inclination to become science boffins, a litany of inconclusive, contradictory and sometimes scary research can stoke the slow burn of pregnancy paranoia into a roaring fire.

Having finished Origins my own doctor’s one-line response after perusing my extensive list of pregnancy-related questions appeals to me more than ever: avoid soft cheeses, enjoy the odd glass of wine with dinner, and stop reading the paper. He might have had a point.

Anna Murphy writes about parenting at thedomesticcorrespondent.com